Fecal incontinence is a common, under-diagnosed, medical affliction. Approximately 1 in 15 of the adult population may develop some degree of fecal incontinence. Its prevalence in the general population ranges between 2.2-6.9% and in the United States alone it involves 5.5 to 17 million people. 30% of the people are over 60 years old, and over 63% are women. The economic impact of incontinence treatment amounts to 16-26 billion USD annually.
The degree of fecal incontinence can be classified into 4 grades: 0—Competent, 1—Gas Incontinence, 2—Soiling and grade 3—Complete (solid content) incontinence.
The causes of chronic incontinence are various and can be divided into 6 main subgroups: 1) Traumatic/Surgical, 2) Inflammatory, 3) Neurology, 4) Psychiatric, 5) Congenital, and 6) Miscellaneous.
Traumatic etiology is the main cause of fecal incontinence. Obstetric trauma and even uncomplicated vaginal deliveries have been found to be a key factor in the development of incontinence in adult women. Other traumatic causes include mechanic trauma, iatrogenic trauma, surgical resection and irradiation. In the inflammatory subgroup of patients with incontinence, the inflammatory bowel diseases (i.e. ulcerative colitis and Crohn's Disease) account for most of the cases. The neurological subgroup includes patients with incontinence due to CVA, multiple sclerosis, spinal cord injury and other autonomic and motor disorders. While advances have been made in the field of urinary incontinence treatment, the management modalities of fecal incontinence offer a very small selection: change of lifestyle, change of diet, experimental use of surgically implantable mechanic sphincter, experimental use of surgically implantable electrical muscle stimulator, and/or experimental surgical sphincter reconstruction.
Change of lifestyle and change of diet (bulk forming) are the first steps generally taken by patients having fecal incontinence.
The implantable mechanic sphincter is a variation of an older urinary sphincter. The device, ring shaped, is surgically inserted around the rectum and is hydraulically inflated/deflated to control the passage.
The implantable electrical muscle stimulator may assist in the treatment of light to moderate fecal incontinence and requires an intact muscular structure of the sphincter.
The surgical reconstruction consists of detaching the distal ends of the gracilis muscles in the legs and overlapping those ends around the rectum to create a new muscular sphincter. The operation usually continues with insertion of an electronic muscle stimulator for the reconstructed sphincter.